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B-2017-1087CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1087 10760 JOHNSON AVE CUPERTINO, CA 95014-3818 (375 31 005) SUNPOWER CORPORATION SYSTEMS SAN JOSE, CA 95134 OWNER'S NAME: YU HENRY DATE ISSUED: 07/07/2017 OWNER'S PHONE: 408-616-9957 [PHONE NO: (941) 720-3850 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class A,B.C-10.0-46 Lic. #890895 Contractor SUNPOWER CORPORATION SYSTEMS Date 02/28/2019 is BLDG _ELECT _PLUMB MECH X RESIDENTIAL _ COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: (N) 14-PANEL ROOF MOUNTED PV SYSTEM (4.83 KW) I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. (7� I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $5000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 375 31 005 375 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 7/7/2017 Issued by: Abby Ayende Date: 07/07/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: t. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 7/7/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 7/7/2017 1 certify that I have read this application and state that the above information is CONSTRUCTION 1,1F.NnlN NCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 7/7/2017 Professional CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCokupertino.org PROJECT ADDRESS , ©(�yQ Je r�k� Y•x� a L APN # '31_0106 J OWNERNAME PHONE kAo%.:\b 9 1ST 7E- STREET ADDRESS 107%()o1„c.scr, /tee CITY, STATE, ZIP L ..o ch Rso\ FAX CONTACT NAME QPM PHONE _ SlcJ2�36Z��-boacylp,CSv. E-MAIL Cccck'> STREET ADDRESS �-ly CS SC S��C CITY, STATE, ZIP F C A FAX El OWNER 13 OWNER -BUILDER 13 OWNER AGENT 12 CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TL\AN"I CONTRACTOR NAME ooc P LICENSE ER C obcts_ LICENSE TYPE . Cab BUS. LIC # COMPANY NAME c` E-MAIL ) - bo cY CGW\ FAX STREET ADDRESS _ . , St' CITY, STATE, ZIP - CJS PHONE ` C—A _S10 Z (11':)t ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX . 7 $ STREET ADDRESS ��► e_- 0 FLoble� CITY, STATE, ZIP Jo Q CA `S13'A PHONE USE OF AFD or Duplex ❑ Multi -Family PROJECT IN WILDLAND _No PROJECT IN STRUCTURE: ❑ Comrnerclal URBAN INTERFACE AREA ❑ Yes (5 FLOOD ZONE ❑ Yes CT-1�0 ❑ SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION 1 ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: DESCRIPTION OF WORK RECEIVED BY: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: " SUPPLEM TAL INTION REQUIRED OFFICE USE ONLY W L1OVER-THE-COUNTER ` l a !� l \ �( IA`` ❑ EXPRESS dE U ❑ STANDARD U ❑ LARGE a ❑ MAJOR PVApp_2011.doc revised 03116111 'IN